Effect of Physicians' Attitudes and Knowledge on the Quality of Antibiotic Prescription: A Cohort Study

Abstract

Resistance increases with the use and abuse of antibiotics. Since physicians are primarily responsible for the decision to use antibiotics, ascertaining the attitudes and knowledge that underlie their prescribing habits is thus a prerequisite for improving prescription. Three-year follow-up cohort study (2008–2010) targeting primary-care physicians (n = 2100) in Galicia, a region in NW Spain. We used data obtained from a postal survey to assess knowledge and attitudes. A physician was deemed to have demonstrated Appropriate Quality Prescription of Antibiotics (dependent variable) in any case where half or more of the indicators proposed by the European Surveillance of Antimicrobial Consumption had values that were better than the reference values for Spain. The mail-questionnaire response rate was 68·0% (1428/2100). The adjusted increase in the interquartile OR of displaying good prescribing of antibiotics for each attitude was: 205% for fear ("When in doubt, it is better to ensure that a patient is cured of an infection by using a broad-spectrum antibiotic"; 95%CI: 125% to 321%); 119% for better knowledge ("Amoxicillin is useful for resolving most respiratory infections in primary care"; 95%CI: 67% to 193%); and 21% for complacency with patients' demands ("Antibiotics are often prescribed due to patients' demands"; 95%CI: 0% to 45%). Due to the fact that physicians' knowledge and attitudes are potentially modifiable, the implementation of purpose-designed educational interventions based on the attitudes identified may well serve to improve antibiotic prescription.

Knowledge About Prescribing Antibiotics for Patients With Acute Pharyngitis and Its Associate Factors Among Primary Health Care Physicians at Ministry of Health Makkah Al-Mukarramah City, 2016.

“…Noted that the main reasons for inappropriate use of antibiotics include physicians' lack of knowledge and training regarding antibiotics, non-adherence to treatment guidelines, uncertainty over the diagnosis, fear of clinical failure, and pressure from patients to prescribe antibiotics. (25) Results of the current study showed that participants' mean knowledge scores about antibiotics prescription for acute pharyngitis patients did not differ significantly according to their personal characteristics, having an antibiotics' prescription policy at PHCC or the application of that policy or according to attendance CME about antibiotics for acute pharyngitis. However, their knowledge differed significantly according to average daily patients' flow, 570 prescribing antibiotics for acute pharyngitis last week, and according to the used type of medical records system at PHCC and among those who read about prescribing antibiotics for acute pharyngitis.…”

“…(18) Gonzalez et al (2015) supported the ability to modify prescriber physicians' knowledge and behavior , even it is a complex and difficult and includes several interventions, (e.g., continuing medical education through interactive group meetings, guidelines). (25) Andrajati et al (2017) emphasized that continuing educational programs and institution-specific guidelines are needed to improve physicians' knowledge regarding antibiotics prescription. (11) Limitations:-…”

Impact of the medical specialty on knowledge regarding multidrug-resistant organisms and strategies toward antimicrobial stewardship

“…Furthermore, ABS requires profound knowledge of local resistance Table 2 Results of four multivariate logistic regression models evaluating the independent influence of several study criteria on predetermined endpoints: (1) attendance of theoretical advanced training courses in the last 12 months (≥1 advanced training courses vs. no training courses), (2) self-reported quality of discharge letters regarding the documentation of MDRO and further outpatient arrangements (always vs. not always), (3) awareness of local ciprofloxacin-resistance rates in E. coli strains (correct category vs. wrong category) and (4) patterns, routine evaluation of antibiotic prescribing, and adherence to existing guidelines. In a recent study by Gonzalez-Gonzalez et al [7], poor theoretical knowledge derived from infrequent or lacking advanced training and was inversely associated with adequate guideline adherence in antibiotic prescribing. According to a study by Hansen et al [12], more than 25% of 40,000 patients received an antibiotic at 132 German hospitals; approximately 40% of these prescriptions were neither indicated nor justifiable.…”

“…After thorough literature review of similar studies and consulting acknowledged experts in the field (working committee "Infectious Diseases" of the German Association of Urology), the questionnaire was developed by the MR2 study group [6][7][8][9][10][11]. In a pilot study, 15 clinicians representing all included medical specialties completed the questionnaire, discussed and modified the items subsequently.…”

“…Several surveys have confirmed the insufficient knowledge of clinicians regarding MDRO and rational use of antibiotics [6][7][8][9][10][11]. In a study on more than 40,000 patients from 132 German hospitals, approximately 40% of antibiotic prescriptions were neither indicated nor justifiable [12].…”